127DELIRIUM PREVENTION IN ELECTIVE ORTHOPAEDIC SURGERY: A QUALITY IMPROVEMENT PROJECT
Notice bibliographique
Résumé
Introduction: Post-operative delirium is a serious complication in elderly patients. This quality improvement project was aimed reducing delirium and length of stay (LOS) in elective orthopaedic patients at Chesterfield Royal Hospital. Methods: Funding was provided by East Midlands Academic Health Science network for a Delirium Nurse Practitioner (DNP). The DNP interviewed 237 elective hip and knee replacement patients between February and August 2017. An Edmonton Frail Score (EFS), 4AT, Montreal Cognitive Assessment (MOCA), Delirium Elderly at Risk (DEAR) score and medical history was completed for each patient. Patients were provided with delirium counselling, written information on delirium and an individualised care plan to be used during their admission. Patient’s with a DEAR>2, EFS > 7, or unstable co-morbidity were referred for pre-operative orthogeriatric assessment. During admission Delirium Observation Scoring (DOS) was implemented. Data on age, sex, LOS and inpatient delirium diagnosis was also collected on 167 patients (no-intervention group) who received hip or knee replacement surgery. Results: Chi square analysis for MOCA was significant at <0.05 for the development of delirium: other scores used were not significant. The intervention commenced in February 2017 and from this point analysis of LOS has shown a reduction in the median LOS: 0.935 days for knee patients and 0.625 for hips. There was no significant difference in the development of delirium between the intervention and no-intervention groups. The median age of the intervention group (73 years, IQR: 67–79) was significantly greater (P < 0.01) than the no-intervention group (67 years IQR 58–75). Conclusion: The project was well received by patients with 78% stating that the information they received about delirium was ‘definitely useful’. Analysis of the LOS data has also shown that the intervention is contributing to a reduction in the median LOS. It is possible that delirium was under diagnosed in the no-intervention group as implementation of DOS may have resulted in higher rates of delirium diagnosis in the intervention group. It could also be suggested that despite accepting older patients for elective hip and knee replacement surgery the incidence of delirium did not increase with the intervention in place. Further work to assess post-operative delirium screening tools and the impact of the intervention in case controlled groups is required.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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